Provider Demographics
NPI:1356530117
Name:BOSTON, ANNA F (DNP-ANP-BC)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:F
Last Name:BOSTON
Suffix:
Gender:F
Credentials:DNP-ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19229 MACK AVE STE 38
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2857
Mailing Address - Country:US
Mailing Address - Phone:313-647-3252
Mailing Address - Fax:313-647-3024
Practice Address - Street 1:19229 MACK AVE STE 23
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2857
Practice Address - Country:US
Practice Address - Phone:313-647-3252
Practice Address - Fax:313-647-3349
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704157116363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704157116OtherNURSE PRACTITIONER